This invention relates to methods for cognitive testing. In particular it relates to such testing for dementia patients with very severe cognitive impairment.
There are currently no psychometric measures or rating scales which permit a detailed description of the mental abilities of dementia patients having very severe cognitive impairment. Consequently, cognitive capacities in, for example, the hundreds of thousands of such patients in nursing homes, are currently not assessed. The method of this invention provides a way to generate cognitive test procedures for dementia patients.
According to a recent demographic report (Weiler, P. G. (1987), "The Public Health Impact of Alzheimer's Disease", American Journal of Public Health, Vol. 77(9), pp. 1157-1158) more than half of the current U.S. population will reach the age of 75 years and one quarter will reach the age 85 years. The prevalence of severe dementia in those over the age of 85 could be as high as 25%. (Cross & Gurland, B. (1986), The Epidemiology of Dementing Disorders, Contract Report, U.S. Office of Technology Assessment). For those between the ages of 75-85 years severe dementia occurs as frequently as myocardial infarct and more frequently than stroke (Oxman, T. E. (1987), Alzheimer's Disease: Molecular Biology, Society Treatment, Psychiatric News, July 3 (pp. 5-7)).
There is a lack of information regarding the cognitive capacities of dementia patients with severe and, especially, very severe cognitive impairment. It is becoming increasingly clear that this information is very important. For example, it is during these more advanced states that institutionalization and pharmacologic intervention often become unavoidable. Consequently, the proper identification of useful pharmacologic intervention modalities and their side effects necessitates improved measures of the cognitive status of these severely and very severely impaired Alzheimer's Disease (AD) patients.
A more comprehensive evaluation of patients at these stages will also result in useful information for caregivers. Specifically, family members frequently ask whether or not the patient "knows" them (i.e., recognizes who they are) or knows they are present at the bedside. This is of more than academic interest because the amount of attention that patients receive in their residential home or institutional setting may be dependent upon the caregiver's notion of the patient's ability to relate to others in the environment. Another impetus for the cognitive assessment of severely impaired patients comes from the Federal Government's Omnibus Budget Act of 1987 (U.S. Code Congressional & Administrative News, 1988) requiring that nursing homes prepare written plans describing their patients' medical, psychological and social conditions and needs. A more detailed assessment of severe and very severely cognitively impaired AD patients' cognitive status may allow for more complete documentation of the psychological condition and for provision of information that could be used in generating rehabilitative procedures that are matched to individual needs and abilities. Despite these needs, prior to the present invention no methods were developed for providing such cognitive test procedures and consequently, the appropriate psychometric measures and rating scales were not available.